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Routine inferior mesenteric artery (IMA) embolisation is unnecessary before endovascular aneurysm repair (EVAR)

Published:November 02, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.11.009
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      Abstract

      Objectives

      A type II endoleak is the most common complication during surveillance after endovascular aneurysm repair (EVAR), and a patent inferior mesenteric artery (IMA) is a known risk factor for an endoleak. The effect of routine IMA embolisation prior to EVAR on overall outcome is unknown. The aim of the study was to compare two strategies: routine attempted IMA embolisation prior to EVAR (strategy/centre A) and leaving the IMA untouched (strategy/centre B).

      Design and methods

      Patients were treated with EVAR in two centres during 2005 - 2015, and the data were reviewed retrospectively. The primary endpoints were reintervention rate due to type II endoleaks and the late IMA embolisation rate. Secondary endpoints included EVAR-related reintervention, sac enlargement, aneurysm rupture and open conversion rates.

      Results

      Strategy A was used to treat 395 patients. The IMA was patent in 268 (67.8%) patients, and embolisation was performed on 164 (41.4%). The corresponding figures for strategy B were 337 patients with 280 (82.8%) patent IMAs, two (0.6%) of which were embolised. The mean follow-up time was 70 months for strategy A and 68.2 months for strategy B. The reintervention rates due to a type II endoleak were 12.9% and 10.4%, respectively (p = .291), with no significant difference in the rate of reinterventions to occlude a patent IMA (2.0% and 4.7%, respectively, p=.039). The EVAR-related reintervention rate was similar regardless of the strategy (24.1% and 24.6%, respectively, p = .931). Significant sac enlargement was seen in 20.3% of the cases with strategy A and in 19.6% with strategy B (p = .821). The rupture and conversion rates were 2.5% and 2.1% (p = .684) and 1.0% and 1.5% (p=.398), respectively.

      Conclusion

      The strategy of routinely embolising the IMA does not seem to yield any significant clinical benefit and should, therefore, be abandoned.

      Keywords

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